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52 <br /> FTA FISCAL YEAR 2017 CERTIFICATIONS AND ASSURANCES <br /> FEDERAL FISCAL YEAR 2017 FTA CERTIFICATIONS AND ASSURANCES SIGNATURE PAGE <br /> (Required of all Applicants for federal assistance to be awarded by FTA and all FTA Grantees with an active Capital or <br /> Formula Award) <br /> AFFIRMATION OF APPLICANT <br /> Name of the Applicant: <br /> Name and Relationship of the Authorized Representative: <br /> BY SIGNING BELOW,on behalf of the Applicant,I declare that it has duly authorized me to make these <br /> Certifications and Assurances and bind its compliance.Thus,it agrees to comply with all federal laws,regulations,and <br /> requirements,follow applicable federal guidance,and comply with the Certifications and Assurances as indicated on <br /> the foregoing page applicable to each application its Authorized Representative makes to the Federal Transit <br /> Administration(FTA)in federal fiscal year 2017,irrespective of whether the individual that acted on his or her <br /> Applicant's behalf continues to represent it. <br /> FTA intends that the Certifications and Assurances the Applicant selects on the other side of this document should <br /> apply to each Award for which it now seeks,or may later seek federal assistance to be awarded during federal fiscal <br /> year 2017. <br /> The Applicant affirms the truthfulness and accuracy of the Certifications and Assurances it has selected in the <br /> statements submitted with this document and any other submission made to FTA,and acknowledges that the Program <br /> Fraud Civil Remedies Act of 1986,31 U.S.C.§3801 et seq.,and implementing U.S.DOT regulations,"Program Fraud <br /> Civil Remedies,"49 CFR part 31,apply to any certification,assurance or submission made to FTA.The criminal <br /> provisions of 18 U.S.C. § 1001 apply to any certification,assurance,or submission made in connection with a federal <br /> public transportation program authorized by 49 U.S.C.chapter 53 or any other statute <br /> In signing this document,I declare under penalties of perjury that the foregoing Certifications and Assurances,and any <br /> other statements made by me on behalf of the Applicant are true and accurate. <br /> Signature Date: <br /> Name <br /> Authorized Representative of Applicant <br /> AFFIRMATION OF APPLICANT'S ATTORNEY <br /> For(Name of Applicant): <br /> As the undersigned Attorney for the above named Applicant,I hereby affirm to the Applicant that it has authority under <br /> state,local,or tribal government law,as applicable,to make and comply with the Certifications and Assurances as <br /> indicated on the foregoing pages.I further affirm that,in my opinion,the Certifications and Assurances have been <br /> legally made and constitute legal and binding obligations on it. <br /> I further affirm that,to the best of my knowledge,there is no legislation or litigation pending or imminent that might <br /> adversely affect the validity of these Certifications and Assurances,or of the performance of its FTA assisted Award. <br /> Signature Date: <br /> Name <br /> Attorney for Applicant <br /> Each Applicant for federal assistance to be awarded by FTA and each FTA Recipient with an active Capital or <br /> Formula Project or Award must provide an Affirmation of Applicant's Attorney pertaining to the Applicant's legal <br /> capacity. The Applicant may enter its electronic signature in lieu of the Attorney's signature within FTA's electronic <br /> award and management system,provided the Applicant has on file and uploaded to FTA's electronic award and <br /> management system this hard-copy Affirmation,signed by the attorney and dated this federal fiscal year. <br /> 46 <br />